Mechanisms of urinary tract infection

doi:10.1016/0090-4295(79)90486-2

Urology

Volume 14, Issue 3, September 1979, Pages 217-225

https://doi.org/10.1016/0090-4295(79)90486-2 Get rights and content

Abstract

Most urinary tract infections begin as a cystitis secondary to decreased host resistance brought on by disruption of tissue integrity or a decrease in blood supply to the bladder. In the female, infrequent voiding and the uninhibited bladder are the most common causes of urinary tract infection and are best treated by healthy voiding regimens; while in the male, structural and functional obstructive uropathy are most often associated with urinary tract infection and are alleviated by lowering the high intravesical pressures via surgical or medical measures. The concept that host resistance is the determinant of infection rather than the organism has permitted the use of clean, intermittent self-catheterization; clean intermittent self-dilatation; and transurethral diverticulectomy in the therapy of a host of urologic disease syndromes.

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Cited by (39)

Urodynamics of the neurogenic bladder
2010, Urologic Clinics of North America
Citation Excerpt :
This technique would later be applied to patients with neurogenic vesical dysfunction from several causes. Lapides,21 in 1979, thought that bladder overdistension induced bladder ischemia, thus exacerbating problems related to infection. If bladder volumes and pressures were kept low, infection would theoretically not be a problem.
Sacral bladder denervation for treatment of detrusor hyperreflexia and autonomic dysreflexia
2001, Urology
Objectives. Detrusor hyperreflexia after spinal cord injury may cause urinary incontinence and chronic renal failure. In patients refractory to conservative treatment and not eligible for ventral sacral root stimulation for electrically induced micturition, we investigated the therapeutic value of sacral bladder denervation as a stand-alone procedure.
Methods. Nine patients (8 men and 1 woman) between 21 and 58 years old (mean 30.2) with traumatic suprasacral spinal cord lesions underwent sacral bladder denervation for treatment of detrusor hyperreflexia and/or autonomic dysreflexia.
Results. Detrusor hyperreflexia and autonomic dysreflexia were eliminated in all cases. Bladder capacity increased from 177.8 ± 39.6 to 668.9 ± 64.3 mL; intravesical pressure decreased from 89.3 ± 19.1 to 20.2 ± 2.7 cm H₂O. For facilitating clean intermittent catheterization (CIC), 4 patients received a continent vesicostomy in a second-stage procedure; one of them in combination with bladder augmentation. Four patients empty their bladder by way of urethral CIC. One completely tetraplegic patient has an indwelling urethral catheter. In the 5 patients with autonomic dysreflexia, the systolic blood pressure was lowered from 196 ± 16.9 to 124 ± 9.3 mm Hg and the diastolic blood pressure from 114 ± 5.1 to 76 ± 5.1. The annual frequency of urinary tract infections decreased from 9 ± 1.2 to 1.8 ± 0.7. In all patients, renal function remained stable.
Conclusions. In selected patients with detrusor hyperreflexia and/or autonomic dysreflexia, sacral bladder denervation is a valuable treatment option. It is only moderately invasive in nature, requires neither sophisticated nor expensive medical equipment, and is an attractive alternative to urinary diversion using intestinal segments.
Intermittent self-catheterization
1990, Clinics in Geriatric Medicine
Case report: Emphysematous cystitis due to Escherichia coli infection with the extension of gas into multiple locations in two non-diabetic dogs: a computed tomographic diagnosis and successful management
2023, Frontiers in Veterinary Science
Intermittent Catheterization (IC)
2019, Neurourology: Theory and Practice
Adult Neurogenic Lower Urinary Tract Dysfunction and Intermittent Catheterisation in a Community Setting: Risk Factors Model for Urinary Tract Infections
2019, Advances in Urology

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^☆: Presidential address presented at the Annual Meeting, North Central Section, American Urological Association, Inc., October 1978.

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Review articleMechanisms of urinary tract infection☆

Abstract

J. Urol.

J. Urol.

An experimental study of the vesical circulation during distention and in cystitis

J. Pathol. Bacteriol.

Effect of distention on blood flow in dog's urinary bladder

Invest. Urol.

The effect and critical duration of increased tissue pressure on susceptibility to bacterial infection

Br. J. Exp. Pathol.

Review article
Mechanisms of urinary tract infection☆